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renal > BPH and ED pharm > Flashcards

BPH and ED pharm Flashcards

1
Q

drugs that can exacerbate BPH

A 
antihistamines
TCAs
phenothiazines
anticholinergics
testosterone
alpha agonists
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2
Q

alpha adrenergic blockers treat ____

A

BPH

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3
Q

alpha adrenergic blockers affect on bladder

A

relax the urethra and reduce smooth muscle contractions in the prostate

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4
Q

alpha adrenergic blockers onset

A

rapid onset and immediate relief of symptoms

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5
Q

alpha adrenergic blockers adverse effects

A

dizziness
orthostatic hypotension
syncope
retrograde ejaculation

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6
Q

can cause intraoperative floppy iris syndrome during cataract surgery

A

alpha adrenergic blockers

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7
Q

what is intraoperative floppy iris syndrome

A

a complication of cataract surgery that can occur while taking alpha adrenergic blockers.

iris prolapse through surgical incision

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8
Q

how to initiate therapy with alpha adrenergic blockers

A

titrate dose over several weeks to minimize side effects
take first dose at bedtime
beware drug interactions

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9
Q

CYP3A4 inducers that increase metabolism of alpha blockers

A

carbamazepine
phenytoin
rifampin

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10
Q

CYP3A4 inhibitors that increase serum concentration of alpha blockers

A

ketoconazole
ritonavir
itraconazole

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11
Q

avoid this rx until after cataract surgery

A

alpha blockers

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12
Q

5a reductase inhibitors

A

finasteride

dutasteride

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13
Q

5a reductase inhibitors MOA

A

inhibition of 5alpha reductase prevents conversion of testosterone to DHT which decreases prostate growth and provides obstruction relief over time

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14
Q

does not immediately relieve LUTS

A

5a reductase inhibitors

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15
Q

use for pts with large prostate volume (>40g)

A

5a reductase inhibitors

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16
Q

5a reductase inhibitors adverse effects

A 
decreased libido 
ED
gynecomastia
decreases serum PSA by 50%
preggos should not touch semen
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17
Q

reduces prostate related hematuria

A

finasteride

18
Q

can decrease serum PSA by 50%

A

5a reductase inhibitors

19
Q

which 5a reductase inhibitor is a CY3A4 inhibitor?

A

dutasteride

20
Q

what should you tell a patient taking 5a reductase inhibitor?

A

emphasize adherence (d/c may cause relapse) and that rx may take 6 months to see effect

21
Q

which BPH rx stops disease progression?

A

5a reductase inhibitors

22
Q

which BPH has cardiovascular adverse effects

A

a blockers

23
Q

when should you use combination 5a reductase inhibitor and alpha blocker?

A

in pts with irritative LUTS and prostate enlargement

24
Q

phosphodiesterase-5 inhibitors

A

tadalafil (cialis)
sildenafil (viagra)
vardenafil (levitra)

25
Q

phosphodiesterase-5 inhibitors MOA

A

inhibits PDE5 in bladder prostate and urethra, increase NO vasodilation

increases cGMP and increases smooth muscle relaxation

26
Q

desired effect of phosphodiesterase-5 inhibitors

A

increased blood flow in corpus cavernous to increase penis size during erection

27
Q

erectile dysfunction causes

A 
PENIS
Psychological, 
Endocrine, 
Neurogenic, 
Insufficient blood flow, 
Substance use.
28
Q

erectile dysfunction

A

consistent inability to gain/maintain penile erection with sufficient rigidity for intercourse

not a symptom of aging

29
Q

what leads to prolonged erection

A

after penis swells and elongates, the corporal tissue compresses venues to decease outflow and prolong erection

30
Q

PDE-5 inhibitors ____ PDE5 which____cGMP and ____ NO vasodilation leading to ______

A

inhibit
increases
increases
prolonged erection

31
Q

PDE5 contraindications

A

nitrates due to risk of hypotension

CVD

32
Q

PDE5 adverse effects

A

headache dizziness
flushing
dyspepsia
visual disturbance

33
Q

rare side effects from PDE5 inhibitors

A

hearing loss
priapism
optic neuropathy

34
Q

what should a pt taking PDE5 inhibitor and alpha blocker be counseled on?

A

take alpha blocker 4 hours apart to avoid orthostatic hypotension

35
Q

T replacement

A

low testosterone

hypogonadism causing ED

36
Q

contraindicated for T replacement

A 
prostate cancer
breast cancer
LUTS
erythrocytosis (Hct>50%)
sleep apnea
HF
37
Q

testosterone patient counseling

A

wash hands after application

allow area to dry, do not get area wet for 5 hours

38
Q

alprostadil

A

prostaglandin that enhances smooth muscle relaxation resulting in filling of corpora and erection

39
Q

alprostadil pt counseling

A

first application done in office to see technique
may have some bleeding
burning can be alleviated by a little rubbing!

40
Q

non-pharm ED treatment

A

reduce alcohol, smoking, drugs
vacuum devices
surgical devices

renal (17 decks)

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